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  1. #1
    Join Date
    Apr 2007
    Posts
    63

    Default Imr Overturn

    My workers compensation claim was made in the State of: ca my question is after IMR OVER TURN UR DENIAL. for how long the overturn good. Insurancr company give me my med .after one minth supply they deny it again.

  2. #2
    Join Date
    Oct 1971
    Posts
    5,138

    Default Re: Imr Overturn

    Quote Quoting mark14 View Post
    My workers compensation claim was made in the State of: ca my question is after IMR OVER TURN UR DENIAL. for how long the overturn good. Insurancr company give me my med .after one minth supply they deny it again.
    The IMR decision is final unless an appeal is filed within 30 days of the decision.
    They must have a valid reason to appeal otherwise the request will be denied, besides those IMR's are too costly to play games with.

    What does IMR cost and who pays for IMR?
    There are costs for IMR and the claims administrator is required to pay those costs.
    For IMR requests submitted on or after Jan. 1, 2015:
    Standard IMRs involving non-pharmacy-only claims*: $390 per IMR.
    Expedited IMRs involving non-pharmacy-only claims*: $515 per IMR.
    Standard IMRs involving pharmacy-only claims**: $345 per IMR.
    IMRs terminated or dismissed before forwarding to a medical professional reviewer: $123 per IMR.
    IMRs terminated or dismissed after forwarding to a medical professional reviewer: $390 per IMR.

    Can an IMR determination be appealed?
    Yes, by filing a petition with the Workers’ Compensation Appeals Board (WCAB) within 30 days of the mailing of the final determination.


    About the appeal process
    The following are the grounds for appeal and the standard is clear and convincing evidence that:
    The AD acted without or in excess of her powers
    The final determination was procured by fraud
    The medical reviewer was subject to a material conflict of interest
    The final determination was the result of bias on the basis of race, national origin, ethnic group identification, religion, age, sex, sexual orientation, color or disability
    The final determination was the result of a plainly erroneous mistake of fact.
    https://www.dir.ca.gov/dwc/IMR/IMR_FAQs.htm

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  3. #3
    Join Date
    Apr 2007
    Posts
    63

    Default Re: Imr Overturn

    Thanks tony this what happens UR deny one of my med.i applied it to IMR. It was OVERTURN different md .request same med. After been OVERTURN UR deny it again Is this right.thank you

  4. #4
    Join Date
    Oct 1971
    Posts
    5,138

    Default Re: Imr Overturn

    Quote Quoting mark14 View Post
    Thanks tony this what happens UR deny one of my med.i applied it to IMR. It was OVERTURN different md .request same med. After been OVERTURN UR deny it again Is this right.thank you
    What you're posting makes no sense unless this is a different med request from a different doctor, if that's the case, yes they can deny it.
    I've reviewed your postings, you're all over the map, posting conflicting statements and making little sense, cool it.
    You claim to have a lawyer, you better have a meeting with him and see what's up.

    Tony
    Moderator Responses are based on my personal bias, experience and research - They do not represent the views of the admin nor may be accepted in the legal community, always consult an attorney.

  5. #5
    Join Date
    Apr 2007
    Posts
    63

    Default Re: Imr Overturn

    Quote Quoting tony View Post
    What you're posting makes no sense unless this is a different med request from a different doctor, if that's the case, yes they can deny it.
    I've reviewed your postings, you're all over the map, posting conflicting statements and making little sense, cool it.
    You claim to have a lawyer, you better have a meeting with him and see what's up.

    Tony
    Tony I don't have a lwayer before I was this why iam using this forum to find help.thank you.

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